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Li M, Fan F, Qiu L, Ma W, Zhang Y. Association of an inter-arm systolic blood pressure difference with all-cause and cardiovascular mortality: A meta-analysis of cohort studies. J Clin Hypertens (Greenwich) 2023; 25:1069-1078. [PMID: 37946576 PMCID: PMC10710559 DOI: 10.1111/jch.14746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
This meta-analysis evaluated the potential association of a simultaneously measured inter-arm systolic blood pressure difference (IASBPD) and all-cause mortality and cardiovascular mortality. The Medline, Cochrane Library, Embase, and PubMed databases were searched through to April 14, 2023 for relevant literature. The outcomes were the associations of IASBPD with all-cause and cardiovascular mortality. Finally, 10 cohort studies that included 15 320 individuals were included. An IASBPD of ≥15 mm Hg was associated with increased all-cause mortality (pooled hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.02-1.61) but an IASBPD of ≥10 mm Hg was not (pooled HR 1.28, 95% CI 0.89-1.85). The pooled HR for cardiovascular mortality was 1.88 (95% CI 1.31-2.71) for an IASBPD of ≥10 mm Hg and 1.93 (95% CI 1.24-2.99) for an IASBPD of ≥15 mm Hg. Subgroup analysis showed that younger patients (HR 9.03, 95% CI 2.00-40.82, p = .004) with an IASBPD ≥15 mm Hg were at higher risk of cardiovascular mortality than older patients (HR 1.67, 95% CI 1.06-2.64, p = .03); the difference between groups was statistically significant (p = .04). In conclusions, our findings show that a simultaneously measured IASBPD ≥15 mm Hg predicts increased all-cause mortality and an IASBPD of ≥15 mm Hg or ≥10 mm Hg predicts increased cardiovascular mortality. An IASBPD ≥15 mm Hg appears to be more correlated with cardiovascular mortality in younger patients than in older patients.
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Affiliation(s)
- Min Li
- Department of Cardiovascular DiseasePeking University First HospitalBeijingChina
| | - Fangfang Fan
- Department of Cardiovascular DiseasePeking University First HospitalBeijingChina
| | - Lin Qiu
- Department of Cardiovascular DiseasePeking University First HospitalBeijingChina
| | - Wei Ma
- Department of Cardiovascular DiseasePeking University First HospitalBeijingChina
- Echocardiography Core LabInstitute of Cardiovascular Disease at Peking University First HospitalBeijingChina
- Hypertension Precision Diagnosis and Treatment Research CenterPeking University First HospitalBeijingChina
| | - Yan Zhang
- Department of Cardiovascular DiseasePeking University First HospitalBeijingChina
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University)Ministry of EducationBeijingChina
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Yu S, Ji H, Lu Y, Chen S, Xiong J, Chi C, Teliewubai J, Fan X, Blacher J, Li J, Zhang Y, Xu Y. Significance of the combination of inter-limb blood pressure differences in the elderly: The Northern Shanghai Study. J Clin Hypertens (Greenwich) 2019; 21:884-892. [PMID: 31210422 DOI: 10.1111/jch.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 01/22/2023]
Abstract
Whether the combination of inter-arm and inter-leg systolic blood pressure differences (BPDs) and ankle-brachial index is of clinical significance remains unclear. In this study, we aimed to investigate the association of the combination of inter-limb systolic BPDs with cardiovascular risk factors and hypertension-mediated organ damage (HMOD). A total of 2621 elderly subjects from the Northern Shanghai Study were divided into Group A, B, and C consisting of participants with 0, 1, and ≥2 abnormal inter-limb systolic BPDs, respectively. Comparisons of cardiovascular risk factors and parameters of cardiac, vascular, and renal damage between groups and logistic regression models were conducted. The proportions of subjects presenting 0, 1, and ≥2 abnormal inter-limb systolic BPDs were 60.9%, 25.1%, and 14.0%, respectively. Upward trends, from Group A, through Group B, to Group C, were observed for the level or prevalence of nearly all cardiovascular risk factors and HMOD (P for trend ≤0.007 for all). In multiple logistic regression, Group C showed significantly higher odds for carotid plaque (vs Group A: Odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.43-2.48; vs Group B: OR = 1.46, 95% CI = 1.08-1.97), arterial stiffness (vs Group A: OR = 1.26, 95% CI = 0.96-1.65; vs Group B: OR = 1.36, 95% CI = 1.01-1.83), and left ventricular hypertrophy (vs Group A: OR = 1.35, 95% CI = 1.04-1.76; vs Group B: OR = 1.25, 95% CI = 0.93-1.67), when compared with Group A and B. In conclusion, the combination of abnormal inter-limb systolic BPDs significantly associates with greater burden of cardiovascular risk factors and higher likelihood for HMOD, especially carotid plaque, arterial stiffness, and left ventricular hypertrophy.
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Affiliation(s)
- Shikai Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongwei Ji
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuyan Lu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shanquan Chen
- School of Clinical Medicine, University of Cambridge, Cambridgeshire, UK
| | - Jing Xiong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chen Chi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiadela Teliewubai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ximin Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jacque Blacher
- Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France
| | - Jue Li
- The Research Institute of Clinical Epidemiology, Tongji University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Rosenberger J, McCrudden S, McCullough C, Wang L, Kime J, Albert NM. Factors associated with inter-arm blood pressure differences in patients admitted to critical care units. Heart Lung 2017; 47:100-106. [PMID: 29248156 DOI: 10.1016/j.hrtlng.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Experts recommend obtaining one-time dual- (inter)-arm blood pressure (BP) measurements to predict cardiovascular morbidity risk. OBJECTIVES To determine differences in inter-arm systolic (S)/diastolic (D) BPs obtained simultaneously and sequentially and examine associations between patient factors and clinical outcomes and inter-arm BP differences. METHOD A comparative study of adults treated in intensive care; multivariable logistic models were created to determine the extent that inter-arm BP differences predicted outcomes. RESULTS Of 427 adults in intensive care units, 31.8% had differences of >10 mmHg on simultaneous measurement and 35.1% had differences of >10 mmHg on sequential measurement; differences >15 mmHg were 17.9% and 19.8%, respectively. After controlling for patient factors, simultaneous inter-arm DBP differences >15 mmHg were associated with shorter hospital and longer intensive care length of stay (p = 0.031 and 0.029, respectively) and a 79% reduction in the likelihood of discharge to home (p = 0.009). CONCLUSIONS Simultaneous inter-arm DBP differences >15 mmHg were associated with clinical outcomes.
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Affiliation(s)
| | | | | | - Lu Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Joni Kime
- Cleveland Clinic Hillcrest Hospital, Mayfield Heights, Ohio
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Sato K, Sugiura T, Ohte N, Dohi Y. Association of physical activity with a systolic blood pressure difference between arms in older people. Geriatr Gerontol Int 2017; 18:95-100. [PMID: 28786517 DOI: 10.1111/ggi.13147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/31/2017] [Accepted: 06/27/2017] [Indexed: 11/29/2022]
Abstract
AIM A increase in interarm systolic blood pressure difference (IASBPD) is believed to lead to increased risk of cardiovascular disease and to be a predictor of future cardiovascular events. The purpose of the present study was to test the hypothesis that an increased IASBPD is associated with reduced physical activity in older people. METHODS Older people who used a geriatric health services facility (n = 147, mean age 83.3 years) were enrolled. The prevalence of IASBPD in individuals with different levels of physical activity and factors that have a crucial effect on IASBPD were investigated. The study participants were divided into three groups according to their physical activity; ambulant persons (group A), wheelchair users (group B) and bedridden persons (group C). Blood pressure around the both brachiums was simultaneously measured using two automated devices. An IASBPD of ≥10 mmHg was considered to be significant IASBPD. RESULTS The median IASBPD was 4.5 mmHg in the present study participants, and 28 participants (19.0%) had an IASBPD ≥10 mmHg. The IASBPD in group C was greater than that in group A or B. Multivariate linear regression analysis showed that physical activity was the independent predictor of IASBPD after adjustment for possible factors. Furthermore, a logistic regression analysis with the end-point of significant IASBPD showed that physical activity is an independent predictor of significant IASBPD. CONCLUSIONS Physical activity simply assessed by moving ability can predict IASBPD in older individuals. In older people, reduced physical activity might indicate the progression of silent or clinical atherosclerosis and an increased risk of cardiovascular disease. Geriatr Gerontol Int 2018; 18: 95-100.
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Affiliation(s)
- Koichi Sato
- Geriatric health services facility, Komakinomori, Komaki, Japan
| | - Tomonori Sugiura
- Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Ohte
- Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuaki Dohi
- Faculty of Rehabilitation Science, Nagoya Gakuin University, Seto, Japan
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Clark CE. The interarm blood pressure difference: Do we know enough yet? J Clin Hypertens (Greenwich) 2017; 19:462-465. [PMID: 28296043 PMCID: PMC8031127 DOI: 10.1111/jch.12982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Weiss A, Rudman Y, Beloosesky Y, Akirov A, Shochat T, Grossman A. High blood pressure variability predicts 30-day mortality but not 1-year mortality in hospitalized elderly patients. Blood Press 2017; 26:259-263. [PMID: 28270031 DOI: 10.1080/08037051.2017.1300859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The association of blood pressure (BP) variability (BPV) in hospitalized patients, which represents day-to-day variability, with mortality has been extensively reported in patients with stroke, but poorly defined for other medical conditions. AIM AND METHOD To assess the association of day-to-day blood pressure variability in hospitalized patients, 10 BP measurements were obtained in individuals ≥75 years old hospitalized in a geriatric ward. Day-to-day BPV, measured 3 times a day, was calculated in each patient as the coefficient of variation of systolic BP. Patients were stratified by quartiles of coefficient of variation of systolic BP, and 30-day and 1-year mortality data were compared between those in the highest versus the lowest (reference) group. RESULTS Overall, 469 patients were included in the final analysis. Mean coefficient of variation of systolic BP was 12.1%. 30-day mortality and 1-year mortality occurred in 29/469 (6.2%) and 95/469 (20.2%) individuals respectively. Patients in the highest quartile of BPV were at a significantly higher risk for 30-day mortality (HR =4.12, CI 1.12-15.10) but not for 1-year mortality compared with the lowest BPV quartile (HR =1.61, CI 0.81-3.23). CONCLUSIONS Day-to-day BPV is associated with 30-day, but not with 1-year mortality in hospitalized elderly patients.
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Affiliation(s)
- Avraham Weiss
- a Department of Geriatrics , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Yaron Rudman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Internal Medicine E , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
| | - Yichayaou Beloosesky
- a Department of Geriatrics , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Amit Akirov
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Unit of Endocrinology and Metabolism , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
| | - Tzippy Shochat
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Bio-statistical Unit , Rabin Medical Center, Beilinson Campus , Petah Tikva , Israel
| | - Alon Grossman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Internal Medicine E , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
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Grossman A, Weiss A, Grossman E. Response to the Letter by Ozturk and Colleagues Entitled: “Inter-Arm Blood Pressure Differences May Be Important in Predicting Mortality”. J Clin Hypertens (Greenwich) 2016; 18:163. [DOI: 10.1111/jch.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alon Grossman
- Department of Internal Medicine E; Rabin Medical Center Beilinson Campus; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Avraham Weiss
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Geriatrics; Rabin Medical Center Beilinson Campus; Petah Tikva Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Internal Medicine D and Hypertension Unit; The Chaim Sheba Medical Center; Tel-Hashomer Israel
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Ozturk C, Balta S, Ozturk A, Aparci M, Sadir S, Celik T. Inter-Arm Blood Pressure Differences May Be Important for Predicting Mortality. J Clin Hypertens (Greenwich) 2015; 18:164. [DOI: 10.1111/jch.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Cengiz Ozturk
- Department of Cardiology; Gulhane Medical Faculty; Ankara Turkey
| | - Sevket Balta
- Department of Cardiology; Gulhane Medical Faculty; Ankara Turkey
| | - Ahmet Ozturk
- Department of Geriatric Medicine; Gulhane Medical Faculty; Ankara Turkey
| | - Mustafa Aparci
- Department of Cardiology; Kasimpasa Military Hospital; Istanbul Turkey
| | - Serdar Sadir
- Department of Physiology; Gulhane Medical Faculty; Ankara Turkey
| | - Turgay Celik
- Department of Cardiology; Gulhane Medical Faculty; Ankara Turkey
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